Tester’s Bipartisan Bill to Lower Drug Costs, Hold Massive PBM Corporations Accountable Clears Key Senate Hurdle

Senator’s Protect Patient Access To Pharmacies Act brings accountability to PBMs, protects patients and small businesses 

U.S. Senator Jon Tester’s bipartisan legislation to hold Pharmacy Benefit Managers (PBMs) accountable recently passed through the Senate Finance Committee, setting it up for a full vote on the Senate floor. Tester introduced this legislation in June alongside U.S. Senators Shelley Moore Capito (R-WV) Sherrod Brown (D-OH), and James Lankford (R-OK).

The Protect Patient Access to Pharmacies Act provides enforcement tools for the “Any Willing Pharmacy” law to support patient choice of pharmacy and pharmacy network adequacy. This law works to ensure that all pharmacy price concessions are assessed at the point of sale and eliminate the retroactive nature of direct and indirect remuneration (DIR) clawback fees imposed by PBMs. The Centers for Medicare and Medicaid Services (CMS) estimates this change will save Medicare beneficiaries an estimated $7.1 to $9.2 billion in reduced cost sharing.

“Rural pharmacies play an essential role in providing life-saving medications, especially in Montana, where these operations are the only way folks can get their prescription medications – and we can’t let them go under because they’re being slammed with predatory hidden fees,” said Tester. “This bill holds corporate middlemen accountable and reduces out-of-pocket costs for hard-working Montanans by finally putting an end to hidden clawback fees that target small-town pharmacies, and I won’t stop working until we get it across the finish line.”

In recent years, PBMs have increasingly returned to pharmacies days or even weeks after the point-of-sale to demand more in DIR fees. From 2010 to 2019, CMS documented a 91,500 percent increase in DIR fees paid by pharmacies.

The Protect Patient Access to Pharmacies Act will increase transparency and hold PBMs accountable by:

• Enforcing and strengthening the federal “any willing pharmacy” law to ensure pharmacies are no longer subject to practices that ultimately limit network participation and steer patients away from pharmacies. 
• Standardizing and overseeing the metrics PBMs and plans use to measure pharmacy performance and quality and ensuring they are fairly applied.
• Ensuring transparency in payments and fees issued by PBMs.

Tester has consistently led the charge to lower prescription drug costs for Montanans. He successfully led the push to close a loophole that will lower out-of-pocket costs for consumers and save Medicare beneficiaries an estimated $21.3 billion over the next ten years by preventing corporate middlemen from retroactively charging rural pharmacies excessive fees for prescription drugs. He also secured more than $68 million for 322 Montana health care providers in the American Rescue Plan Act, to help rural providers across the Treasure State keep the lights on and provide critical care to families and communities in the wake of the COVID-19 pandemic.